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Semnani-Azad Z, Gaillard R, Hughes AE, Boyle KE, Tobias DK, Perng W. Predictors and risk factors of short-term and long-term outcomes among women with gestational diabetes mellitus (GDM) and their offspring: Moving toward precision prognosis? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.14.23288199. [PMID: 37131686 PMCID: PMC10153333 DOI: 10.1101/2023.04.14.23288199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
As part of the American Diabetes Association Precision Medicine in Diabetes Initiative (PMDI) - a partnership with the European Association for the Study of Diabetes (EASD) - this systematic review is part of a comprehensive evidence evaluation in support of the 2 nd International Consensus Report on Precision Diabetes Medicine. Here, we sought to synthesize evidence from empirical research papers published through September 1 st , 2021 to evaluate and identify prognostic conditions, risk factors, and biomarkers among women and children affected by gestational diabetes mellitus (GDM), focusing on clinical endpoints of cardiovascular disease (CVD) and type 2 diabetes (T2D) among women with a history of GDM; and adiposity and cardiometabolic profile among offspring exposed to GDM in utero. We identified a total of 107 observational studies and 12 randomized controlled trials testing the effect of pharmaceutical and/or lifestyle interventions. Broadly, current literature indicates that greater GDM severity, higher maternal body mass index, belonging to racial/ethnic minority group; and unhealthy lifestyle behaviors would predict a woman's risk of incident T2D and CVD, and an unfavorable cardiometabolic profile among offspring. However, the level of evidence is low (Level 4 according to the Diabetes Canada 2018 Clinical Practice Guidelines for diabetes prognosis) largely because most studies leveraged retrospective data from large registries that are vulnerable to residual confounding and reverse causation bias; and prospective cohort studies that may suffer selection and attrition bias. Moreover, for the offspring outcomes, we identified a relatively small body of literature on prognostic factors indicative of future adiposity and cardiometabolic risk. Future high-quality prospective cohort studies in diverse populations with granular data collection on prognostic factors, clinical and subclinical outcomes, high fidelity of follow-up, and appropriate analytical approaches to deal with structural biases are warranted.
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Dugas C, Brassard D, Bélanger M, Perron J, Weisnagel SJ, Marc I, Robitaille J. Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:378-387. [PMID: 35151604 DOI: 10.1016/j.jneb.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM-); to study the association between mother and child vegetables and fruit (VF) intakes. DESIGN Cross-sectional study. PARTICIPANTS One hundred forty-two children (104 GDM+; 38 GDM-) aged 6.2 ± 2.5 years. VARIABLES Canadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires. ANALYSIS Linear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status. RESULTS Family meals were associated with HEI-C among GDM- but not GDM+ children (β = 9.97, P = 0.01 and β = -0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = -1.45; 95% confidence interval, -2.19 to -0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r2 = 0.09), with association of larger variance among GDM- children (r = 0.38, r2 = 0.14, P = 0.02) than GDM+ children (r = 0.23, r2 = 0.05, P = 0.02). CONCLUSIONS The food environment at home was associated differently with the diet quality of GDM+ and GDM- children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.
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Affiliation(s)
- Camille Dugas
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada; School of Nutrition, Laval University, Quebec City, Canada; Endocrinology and Nephrology Unit, University Hospital of Quebec-Laval University Research Center, Quebec City, Canada
| | - Didier Brassard
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada; School of Nutrition, Laval University, Quebec City, Canada
| | - Mélissa Bélanger
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada; School of Nutrition, Laval University, Quebec City, Canada; Endocrinology and Nephrology Unit, University Hospital of Quebec-Laval University Research Center, Quebec City, Canada
| | - Julie Perron
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada
| | - S John Weisnagel
- Endocrinology and Nephrology Unit, University Hospital of Quebec-Laval University Research Center, Quebec City, Canada
| | - Isabelle Marc
- Department of Pediatrics, University Hospital of Quebec-Laval University Research Center, Laval University, Quebec City, Canada
| | - Julie Robitaille
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada; School of Nutrition, Laval University, Quebec City, Canada; Endocrinology and Nephrology Unit, University Hospital of Quebec-Laval University Research Center, Quebec City, Canada.
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Saidj S, Ruchat SM, Henderson M, Drapeau V, Mathieu ME. Which healthy lifestyle habits mitigate the risk of obesity and cardiometabolic risk factors in Caucasian children exposed to in utero adverse gestational factors? Nutr Metab Cardiovasc Dis 2021; 31:286-296. [PMID: 33121841 DOI: 10.1016/j.numecd.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/23/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS This study explored if lifestyle habits [physical activity (PA), sleep duration, intake of fruits and vegetables, grains, and dairy products] can moderate the positive associations between prenatal exposure to suboptimal gestational factors (SGF: i.e. gestational diabetes mellitus, hypertensive disorders during pregnancy, maternal smoking during pregnancy) and obesity and cardiometabolic risk factors in children. METHODS AND RESULTS Data from the "Quebec Adiposity and Lifestyle Investigation in Youth" (QUALITY) study collected between 2005 - 2008 in Montreal and Quebec City, were used. Analyses included a sample of 619 children aged 8-10 years. Children's PA and sleep duration were obtained using an accelerometer and daily servings of food were assessed using three 24 h diet recalls. Moderation analyses were performed to investigate if each lifestyle habit, in all children, and in boys and girls, could reduce the positive associations between SGF, and obesity and cardiometabolic risk factors. High LPA duration was protective against low levels of HDL cholesterol in boys who were exposed to more than one SGF (p = 0.005). Sleep duration did not have a protective effect respectively against high waist circumference and obesity in children and girls who were prenatally exposed to maternal smoking during pregnancy. Diet and MVPA did not moderate the positive associations between SGF, obesity and cardiometabolic risk factors in children. CONCLUSION Among the three lifestyle habits, only LPA had a protective effect against low levels of HDL-cholesterol in boys. More studies are needed to confirm these results to inform future lifestyle intervention in this population.
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Affiliation(s)
- Soraya Saidj
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, QC, Canada
| | - Stephanie-M Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Melanie Henderson
- Research Center, Sainte-Justine University Hospital Center, Montréal, QC, Canada; Department of Pediatrics, Université de Montréal, QC, Canada
| | - Vicky Drapeau
- Department of Physical Education, Faculty of Educational Sciences, Université de Laval, Québec, QC, Canada
| | - Marie-E Mathieu
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Center, Montréal, QC, Canada.
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Sauder KA, Bekelman TA, Harrall KK, Glueck DH, Dabelea D. Gestational diabetes exposure and adiposity outcomes in childhood and adolescence: An analysis of effect modification by breastfeeding, diet quality, and physical activity in the EPOCH study. Pediatr Obes 2019; 14:e12562. [PMID: 31274243 PMCID: PMC6844624 DOI: 10.1111/ijpo.12562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intrauterine exposure to gestational diabetes (GDM) is associated with increased adiposity; however, not all offspring exposed to GDM exhibit excess adiposity. OBJECTIVES Examine whether optimal diet and activity behaviours in infancy, childhood, and adolescence modify the association between GDM exposure and adiposity. METHODS In 564 offspring (84 exposed to GDM), we assessed breastfeeding (maternal recall), dietary intake (food frequency questionnaire), physical activity (3-day recall), and adiposity (BMI, waist-to-height ratio, visceral and subcutaneous adipose tissue, and subscapular-to-triceps skinfold ratio) at 10.4 (SD, 1.5) and 16.7 (SD, 1.2) years. Optimal behaviours were defined as >6 breastmilk months, Healthy Eating Index score >60, and daily vigorous activity >1 hour. Linear mixed models assessed the association between GDM exposure and adiposity among those with optimal versus suboptimal health behaviours, adjusting for sex, race/ethnicity, age, and pubertal status. RESULTS GDM exposure was associated with increased skinfold ratio, visceral and subcutaneous adipose tissue among those with <6 breastmilk months (all Ps < .05), but only associated with increased skinfold ratio among those with >6 breastmilk months (P = .01). GDM exposure was associated with increases in all adiposity measures among those with Healthy Eating Index scores <60 (P < .01), but not those with scores >60 (P > .10). GDM exposure was associated with increased BMI and subcutaneous adipose tissue among those with >1 hour of vigorous activity (P < .05) but not among those with <1 hour of vigorous activity (P > .30). CONCLUSIONS The association of GDM exposure with excess adiposity is attenuated in offspring with more optimal diet and activity behaviours in infancy, childhood, and adolescence.
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Affiliation(s)
- Katherine A Sauder
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Traci A Bekelman
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Kylie K Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Deborah H Glueck
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
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Bélanger M, Dugas C, Perron J, Ruchat SM, Weisnagel SJ, Marc I, Tchernof A, Robitaille J. Association between lifestyle habits and adiposity values among children exposed and unexposed to gestational diabetes mellitus in utero. Diabetes Metab Syndr 2019; 13:2947-2952. [PMID: 31425961 DOI: 10.1016/j.dsx.2019.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Abstract
AIMS The objectives of this study were to assess the profile of lifestyle habits among children exposed (GDM+) or unexposed (GDM-) to GDM and to assess whether a healthy lifestyle profile is associated with lower adiposity values among these children. METHODS A total of 105 GDM+ and 38 GDM- children aged 2-14 years were included. Vegetables and fruit intakes were collected using two 24-h dietary recalls. Physical activity and sedentary time were measured with accelerometers. Screen and sleep time were assessed using questionnaires. Weight, height and waist circumference were measured. Body composition was assessed by absorptiometry. RESULTS GDM+ children had lower moderate-to-vigorous physical activity practice (p = 0.043) and fruit intake (p = 0.020) than GDM- children. Among children with an unhealthy lifestyle (meeting 0-2 lifestyle recommendations), GDM+ children had greater percentage of fat mass (p = 0.021) and android fat mass (p = 0.020) than GDM- children. Moreover, among GDM+ children, children with a healthy lifestyle (meeting 3-4 lifestyle recommendations) tended to have lower percentage of fat mass (p = 0.053) and android fat mass (p = 0.071) than those with an unhealthy lifestyle. CONCLUSION Improving lifestyle habits among GDM+ children could represent a promising approach to prevent deteriorated adiposity values.
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Affiliation(s)
- Mélissa Bélanger
- School of Nutrition, Laval University, Québec, Québec, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada
| | - Camille Dugas
- School of Nutrition, Laval University, Québec, Québec, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada
| | - Julie Perron
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - S John Weisnagel
- Endocrinology and Nephrology Axis, CHU de Quebec Research Center, Québec, Québec, Canada; Diabetes Research Unit, Laval University Medical Research Center, Québec, Québec, Canada
| | - Isabelle Marc
- Department of Pediatrics, Laval University, CHU de Quebec Research Center, Québec, Québec, Canada
| | - André Tchernof
- School of Nutrition, Laval University, Québec, Québec, Canada; Quebec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, Québec, Québec, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada; Endocrinology and Nephrology Axis, CHU de Quebec Research Center, Québec, Québec, Canada.
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Simmons D. GDM and Nutrition-Answered and Unanswered Questions-There's More Work to Do! Nutrients 2019; 11:nu11081940. [PMID: 31426514 PMCID: PMC6722957 DOI: 10.3390/nu11081940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is the commonest medical pregnancy complication, and a growing problem around the world as the obesity epidemic continues. Ways to prevent GDM are urgently required, the management of GDM still poses many unanswered questions, and the postpartum prevention of the progression of GDM to type 2 diabetes remains a challenge. With GDM, the impact of any intervention on the offspring is always a major concern. Nutritional interventions come to the fore as one of our few levers in reducing the short-term pregnancy risk and long-term cardiometabolic risks to both mother and child. This special issue reports on the relationship between several nutrients and foods and the development and management of GDM, behavioural strategies to enhance lifestyle choices, the issues raised by prior bariatric surgery and ways to screen for GDM. The work identifies further unanswered questions over nutritional strategies to reduce the impact of GDM.
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Affiliation(s)
- David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW 2560, Australia.
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